Anterior to the psoas surgical access system and a modified surgical approach technique

Abstract

An supine anterior-to-psoas approach includes a patient being rotated for the initial approach. Further, various blades and retractor rings provide various features to allow for the supine ATP approach or a conventional ATP to be performed.

The invention claimed is: 
     
         1 . A method for surgically approaching the spine of a patient for spinal surgery, comprising:
 positioning the patient on an operating table in supine position in an approximately horizontal orientation;   rotating the patient about a superior-inferior axis of the patient, so that the patient's left side is higher than the patient's right side;   performing an anterior-to-psoas (ATP) surgical approach to the spine;   placing one or more retractors to create a surgical corridor to the spine;   affixing the one or more retractors to a retractor frame;   rotating the patient back to the approximately horizontal position;   performing a surgical procedure though the surgical corridor; and   configuring the retractor frame which is a supine ATP ring with a first hinge arranged at a cranial position and a second hinge arranged at a caudal position wherein the hinges are angled at approximately 20 degrees to 30 degrees.   
     
     
         2 . The method of  claim 1 , comprising securing the patient to the operating table, wherein rotating the patient includes rotating the operating table. 
     
     
         3 . The method of  claim 1 , comprising deploying one or more positioners on the right side of the patient. 
     
     
         4 . The method of  claim 1 , comprising deploying a first positioner under the right arm of the patient and a second positioner just above the right knee. 
     
     
         5 . The method of  claim 1 , comprising determining the location of an incision using imaging to identify an appropriate in-line trajectory to a targeted lumbar disc space. 
     
     
         6 . The method of  claim 5 , comprising marking the abdominal wall at the anterior axillary line based upon the identified in-line trajectory. 
     
     
         7 . The method of  claim 1 , wherein the one or more retractors comprise one or more retractor blades, and wherein at least one of the retractor blades is a flat end blade that is placed adjacent to a psoas muscle. 
     
     
         8 . The method of  claim 7 , wherein the flat end blade is connected to the supine ATP ring at a position between the hinges on the left side of the patient. 
     
     
         9 . The method of  claim 1 , wherein the patient is rotated approximately 20 degrees to 30 degrees. 
     
     
         10 . The method of  claim 1 , wherein a first retractor of the one or more retractors has a first blade, a second retractor of the one or more retractors has a second blade that is placed at an approximal cranial position on the supine ATP ring, and a third retractor of the one of the one or more retractors has a third blade that is placed at an approximal caudal position on the supine ATP ring. 
     
     
         11 . The method of  claim 10 , further comprising securing the second blade and the third blade to a vertebral body. 
     
     
         12 . The method of  claim 1 , wherein each retractor of the one or more retractors comprises a retractor blade wherein the retractor blade is a reverse tip blade that is placed to retract a left psoas muscle from the surgical corridor and attached at a position between the hinges on the right side of the patient. 
     
     
         13 . The method of  claim 1 , comprising performing a disc preparation on the left side of the patient. 
     
     
         14 . The method of  claim 1 , comprising implanting a device in the spine. 
     
     
         15 . The method of  claim 14 , comprising delivering the device to the spine using a sliding element in a channel of a retractor blade of the one or more retractors. 
     
     
         16 . The method of  claim 1 , comprising lighting the surgical corridor using a light source on a sliding element in a channel of a retractor blade of the one or more retractors. 
     
     
         17 . The method of  claim 1 , comprising applying suction to the surgical corridor using a suction device on a sliding element in a channel of a retractor blade of the one or more retractors. 
     
     
         18 . The method of  claim 1 , comprising lighting the surgical corridor using a light source in a channel of a retractor blade of the one or more retractors, wherein the channel extends from the top of a base of the retractor blade to a surface of the retractor blade facing the surgical corridor. 
     
     
         19 . The method of  claim 1 , comprising applying suction to the surgical corridor using a suction device in a channel of a retractor blade of the one or more retractors, wherein the channel extends from the top of a base of the retractor blade to a surface of the retractor blade facing the surgical corridor. 
     
     
         20 . The method of  claim 1 , comprising securing a retractor blade of the one or more retractors to a vertebral body using a fastener inserted through a fastening channel extending along the length of the retractor blade. 
     
     
         21 . A method for surgically approaching the spine of a patient for spinal surgery, comprising:
 positioning the patient on an operating table in supine position in an approximately horizontal orientation;   rotating the patient about a superior-inferior axis of the patient, so that the patient's left side is higher than the patient's right side;   performing an anterior-to-psoas (ATP) surgical approach to the spine;   placing one or more retractors to create a surgical corridor to the spine;   affixing the one or more retractors to a retractor frame;   rotating the patient back to the approximately horizontal position;   performing a surgical procedure though the surgical corridor;   determining the location of an incision using imaging to identify an appropriate in-line trajectory to a targeted lumbar disc space; and   marking the abdominal wall at the anterior axillary line based upon the identified in-line trajectory.